ANTIDEPRESSANT AGENTS Lexi-Drugs Online Comparison of Usual Dosage, Mechanism of Action, and Adverse Effects Drug Initial Dose Usual Dosage (mg/d) Dosage Forms Adverse Effects ACH Drowsiness Orthostatic Hypotension Conduction Abnormalities GI Weight Distress Gain Comments
Tricyclic Antidepressants and Related Compounds1 Amitriptyline (Elavil®, Vanatrip®) Amoxapine Clomipramine2 (Anafranil®) Desipramine (Norpramin®) Doxepin (Sinequan®, Zonalon®) Imipramine (Tofranil®, TofranilPM®) Maprotiline (Ludiomil®) Nortriptyline (Aventyl®, Pamelor®) Protriptyline (Vivactil®) Trimipramine (Surmontil®) 25-75 mg qhs 50 mg bid 25-75 mg qhs 25-75 mg qhs 25-75 mg qhs 25-75 mg qhs 25-75 mg qhs 25-50 mg qhs 15 mg qAM 25-75 mg qhs 20 mg qAM 100-300 T, I 4+ 4+ 3+ 3+ 1 4+ Also used in chronic pain, migraine, and as a hypnotic; contraindicated with cisapride May cause extrapyramidal symptom (EPS) Approved for OCD
100-400 100-250
T C
2+ 4+
2+ 4+
2+ 2+
2+ 3+
0 1+
2+ 4+
100-300
T
1+
2+
2+
2+
0
1+
Blood levels useful for therapeutic monitoring
100-300
C, L
3+
4+
2+
2+
0
4+
100-300
T, C
3+
3+
4+
3+
1+
4+
Blood levels useful for therapeutic monitoring
100-225
T
2+
3+
2+
2+
0
2+
50-150
C, L
2+
2+
1+
2+
0
1+
Blood levels useful for therapeutic monitoring
15-60 100-300
T C
2+ 4+
1+ 4+
2+ 3+
3+ 3+
1+ 0
1+ 4+
Selective Serotonin Reuptake Inhibitors3 Citalopram (CelexaTM) 20-60 T 0 0 0 0 3+4 1+
Comparison of Usual Dosage, Mechanism of Action, and Adverse Effects Drug Initial Dose 10 mg qAM 10-20 mg qAM 50 mg qhs 10-20 mg qAM 25-50 mg qAM 100 mg bid-tid IR5 150 mg qAMbid SR6 40-60 mg/d Usual Dosage (mg/d) 10-20 20-80 Dosage Forms T C, L, T Adverse Effects ACH Drowsiness 0 0 0 0 0 0 Orthostatic Hypotension 0 0 Conduction Abnormalities GI Weight Distress Gain 3+ 3+4 1+ 1+ S-enantiomer of citalopram CYP2B6 and 2D6 inhibitor Comments
Escitalopram (LexaproTM) Fluoxetine (Prozac®, Prozac® WeeklyTM, SarafemTM) Fluvoxamine (Luvox®)2 Paroxetine (Paxil®, Paxil® CRTM) Sertraline (Zoloft®)
100-300
T
0
0
0
0
3+4
1+
Contraindicated with pimozide, thioridazine, mesoridazine, CYP1A2, 2B6, 2C19, and 3A4 inhibitors CYP2B6 and 2D6 inhibitor
20-50
T, L
1+
1+
0
0
3+4
2+
50-200
T
0
0
0
0
3+4
1+
CYP2B6 and 2C19 inhibitor
Dopamine-Reuptake Blocking Compounds Bupropion (Wellbutrin®, Wellbutrin SR®, Wellbutrin XLTM, Zyban®) 300-4507 T 0 0 0 1+/0 1+ 0 Contraindicated with seizures, bulimia, and anorexia; low incidence of sexual dysfunction IR: A 6-h interval between doses preferred SR: An 8-h interval between doses preferred
Serotonin / Norepinephrine Reuptake Inhibitors8 Duloxetine (Cymbalta®) 40-60 75-375 C T 1+ 1+ 1+ 1+ 0 0 1+ 1+ 3+ 3+4 0 0 Useful for stress incontinence and chronic pain High-dose is useful to treat refractory depression; frequency of hypertension increases with dosage >225 mg/d
Venlafaxine 25 mg (Effexor®, Effexor® XR) bid-tid IR 37.5 mg qd XR Nefazodone 100
5HT2 Receptor Antagonist Properties 300-600 T 1+ 1+ 2+ 1+ 1+ 0 Contraindicated with carbamazepine, pimozide,
Comparison of Usual Dosage, Mechanism of Action, and Adverse Effects Drug Initial Dose mg bid 50 mg tid 150-600 T 0 4+ 3+ 1+ 1+ 2+ Usual Dosage (mg/d) Dosage Forms Adverse Effects ACH Drowsiness Orthostatic Hypotension Conduction Abnormalities GI Weight Distress Gain astemizole, cisapride, and terfenadine; caution with triazolam and alprazolam; low incidence of sexual dysfunction Comments
(Serzone®)
Trazodone (Desyrel®)
Noradrenergic Antagonist Mirtazapine 15 mg (Remeron®, Remeron® qhs SolTabTM) Isocarboxazid (Marplan®) Phenelzine (Nardil®) Tranylcypromine (Parnate®) 10 mg tid 15 mg tid 10 mg bid 15-45 T 1+ 3+ 1+ 1+ 0 3+ Dose >15 mg/d less sedating, low incidence of sexual dysfunction
Monoamine Oxidase Inhibitors 10-30 15-90 10-60 T T T 2+ 2+ 2+ 2+ 2+ 1+ 2+ 2+ 2+ 1+ 0 1+ 1+ 1+ 1+ 2+ 3+ 2+ Diet must be low in tyramine; contraindicated with sympathomimetics and other antidepressants
ACH = anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation); 0 - 4+ = absent or rare - relatively common. T = tablet, L = liquid, I = injectable, C = capsule; IR = immediate release, SR = sustained release.
1 2 3 4 5 6 7 8
Important note: A 1-week supply taken all at once in a patient receiving the maximum dose can be fatal. Not approved by FDA for depression. Approved for OCD. Flat dose response curve, headache, nausea, and sexual dysfunction are common side effects for SSRIs. Nausea is usually mild and transient. IR: 100 mg bid, may be increased to 100 mg tid no sooner than 3 days after beginning therapy. SR: 150 mg qAM, may be increased to 150 mg bid as early as day 4 of dosing. To minimize seizure risk, do not exceed IR 150 mg/dose or SR 200 mg/dose. Do not use with sibutramine; relatively safe in overdose.